Thyroidectomy: Everything You Need to Know

Surgical removal of the thyroid gland

Table of Contents
View All
Table of Contents

Thyroid surgery (thyroidectomy) involves the removal of some or all of the thyroid gland. This operation may be done to treat a number of diseases and conditions, including thyroid cancer, symptomatic goiter, or a thyroid gland that is producing excessive thyroid hormone (hyperthyroidism).

This butterfly-shaped gland is located at the base of your neck in front of your windpipe (trachea). It produces hormones that regulate your body's metabolism and temperature. While a partial thyroidectomy may not impact this, total removal of the thyroid means you will need lifelong hormone treatment to maintain these functions.

3:15

What Is a Thyroidectomy?

There are different kinds of thyroid surgery, and the type chosen depends on the reason you are having it done:

  • Total or near-total thyroidectomy: This involves the removal of all or most of the thyroid gland. This surgery is often indicated for large thyroid cancers, large goiters, and Graves' disease.
  • Hemithyroidectomy or thyroid lobectomy: This involves the removal of one of the two lobes of the thyroid gland. This option may be indicated if a thyroid nodule is small and localized to one side of the thyroid gland.
  • Isthmusectomy: This involves the removal of the isthmus, the bridge of tissue that crosses over the middle of your trachea and sits between the two thyroid lobes. This surgery is reserved for the removal of small tumors located in the isthmus itself.

Regardless of the type, thyroid surgery is typically a scheduled inpatient procedure performed in a hospital. Less commonly, it may be performed on an outpatient basis in a surgical center.

Research suggests that in the right circumstances—for example, the patient has support at home during recovery and lives within a reasonable distance from a hospital—outpatient thyroid surgery may be just as safe as inpatient thyroid surgery.

Surgical Techniques

There are three surgical techniques that may be used to perform thyroid surgery:

  • Open: With this approach, all or part of the thyroid gland is removed through a single large incision made across the base of the neck in the front.
  • Endoscopic surgery: With this minimally invasive approach, a few small incisions are made in various areas of the body (the neck, underarm, front of the chest, breast, behind the ear, or through the mouth). A long, thin instrument that has a camera attached to it, called an endoscope, is inserted into one of the incisions to visualize the gland. Various surgical instruments are then inserted through other incisions to remove the thyroid.
  • Robotic surgery: As with endoscopic surgery, small incisions are made (e.g., under the arm and in the chest). However, instead of the surgeon inserting instruments on their own, the surgeon controls robotic hands that have surgical instruments attached to them.

Endoscopic and robotic thyroid surgery leave less visible scarring and are associated with a faster recovery. That said, these minimally invasive techniques should only be performed in carefully chosen patients and by highly experienced surgeons.

Contraindications

Contraindications to thyroid surgery include:

  • Heart, lung, or other debilitating underlying illness
  • Hyperthyroidism in pregnancy, unless the patient cannot tolerate an antithyroid medication
  • Uncontrolled Grave's disease (medical stabilization is generally required first)

Potential Risks

Thyroidectomy: Side Effects and Complications
Verywell / Brianna Gilmartin

Specific risks associated with thyroid surgery include:

  • Postsurgical hematoma, which causes bleeding that can lead to respiratory distress
  • Recurrent laryngeal nerve damage, which can result in temporary or permanent hoarseness
  • Damage to the parathyroid glands, located behind your thyroid, which can lead to temporary or permanent hypoparathyroidism and hypocalcemia
  • Injury to the trachea or esophagus (the tube that carries food from your mouth to your stomach)
  • Difficulty swallowing (dysphagia)
  • Horner syndrome
  • Chyle fistula (leaking of lymphatic fluid into the chest area)

Purpose of Thyroid Surgery

The purpose of thyroid surgery is to eradicate cancer (or a possible malignancy) or reduce the symptoms and impact of a thyroid condition.

Specific indications for thyroid surgery vary from surgeon to surgeon. That said, common ones include:

  • A thyroid nodule that is suspicious for cancer or found to be cancerous
  • A goiter or benign (non-cancerous) thyroid nodule that is large, increasing in size, and/or causing symptoms like discomfort or problems breathing or swallowing
  • Toxic nodule, toxic multinodular goiter, or Graves' disease (all of which cause hyperthyroidism)

When thyroid surgery is being considered, various tests will be performed including a blood thyroid-stimulating hormone (TSH) test and a blood calcium level. Thyroid ultrasound images and/or fine-needle aspiration (FNA) biopsy reports will also be evaluated.

With a diagnosis of thyroid cancer, imaging tests like a computed tomography (CT) scan of the chest are generally performed to determine if the cancer has spread.

Since thyroid surgery may result in injury or trauma to the recurrent laryngeal nerve (RLN), some surgeons also perform a routine laryngoscopy to evaluate for any baseline vocal cord problems.

Overall, these tests help the surgeon confirm the need for surgery and guide their surgical approach or technique.

When thyroid surgery is scheduled, various pre-operative tests for medical and anesthesia clearance will need to be run.

Such tests include:

How to Prepare

Once you are scheduled for thyroid surgery, your surgeon will give you instructions on how to best prepare. If you have any questions, be sure to ask them, as not complying with certain recommendations may impact whether or not your surgery can take place on the day it is scheduled.

Location

Thyroid surgery is performed in a hospital or surgical center by a general surgeon or a head and neck surgeon (called an otolaryngologist).

Your surgeon will probably ask that you arrive at least two hours early on the day of your operation.

You should pre-arrange to have someone drive you home when you have been discharged.

Food and Drink

Avoid eating or drinking after midnight on the eve of your surgery.

Medications

You will be advised to stop taking certain medications for a designated period of time. For instance, most surgeons advise patients to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) a week before surgery.

Be sure to tell your surgeon if you are taking aspirin. It may or may not need to be discontinued prior to surgery, depending on the reason you are taking it.

To help prevent surgical complications, it's essential to inform your surgeon of all of the drugs you are taking including prescription and over-the-counter medications, dietary supplements, herbal remedies, and recreational drugs.

What to Wear and Bring

Since you will change into a hospital gown upon arrival at the hospital or surgical center, it's sensible to wear loose-fitting clothes that are easy to remove. Leave all valuables, including jewelry, at home.

Make sure you bring your driver's license, insurance card, and a list of your medications.

If you are staying overnight in the hospital, you will want to pack a bag the night before your surgery. In addition to personal care items (like a toothbrush) and comfort items (like a book), be sure to pack:

  • Any medical devices you use (e.g., CPAP machine for sleep apnea)
  • Loose-fitting clothes to go home in, especially a wide-neck or button-down shirt

Pre-Op Lifestyle Changes

Getting regular aerobic exercise before surgery can help you recover faster and easier. Check with your surgeon to see if this is appropriate for you.

If you drink alcohol, be sure to have a candid conversation with your surgeon about how much you drink. You will want to try and stop drinking alcohol once your thyroid surgery is scheduled.

Watch out for and tell your healthcare provider if you develop any symptoms of alcohol withdrawal as you stop drinking (e.g., nausea, increased anxiety, or insomnia). These symptoms need to be treated to prevent severe complications like seizures.

If you smoke, quitting even a few days before surgery can help prevent surgical complications (though sooner is, of course, better). Your surgeon may be able to refer you to a smoking cessation program to help you during this process.

What to Expect on the Day of Surgery

On the day of your thyroid surgery, you will arrive at the hospital or surgical center and check-in.

Before the Surgery

Next, you will be taken to a pre-operative room where you will change out of your clothes into a hospital gown. A nurse will then review your medication list, record your vitals, and place an intravenous (IV) line for administering fluids and medications into a vein in your arm.

Your surgeon will come to greet you and briefly review the operation. From there, you will be wheeled into the operating room on a gurney where the anesthesia process and surgery will start.

During the Surgery

Thyroid surgery takes around two to three hours and may be performed under regional or general anesthesia.

  • Regional anesthesia: The surgeon will inject a numbing medication into your neck (called a cervical block). You may feel a stinging sensation as the medication is being injected. You will also be given a light sedative to help you fall asleep during the surgery.
  • General anesthesiaThe surgeon will perform a cervical block. Then, the anesthesiologist will administer inhaled or intravenous medication to put you to sleep. Once asleep, a breathing tube called an endotracheal tube will be inserted to allow for mechanically-assisted breathing during the operation.

Once you are asleep, a surgical assistant will place inflatable compression devices on your legs to help prevent post-operative blood clots. You may also receive a dose of an intravenous steroid to help reduce hoarseness, nausea, and vomiting after surgery (which is common).

While the exact surgical flow depends on the surgical technique/approach used, you can generally expect the following steps:

  • Incision(s): The surgeon will make one or more incisions over the neck, chest, underarm, or other designated sites. The size of the incision depends on whether the surgery is open (larger) or endoscopic/robotic (smaller).
  • Exposure: The skin and muscle will be pulled back to expose the thyroid gland. Blood supply to the gland will be tied off, and the parathyroid glands will be identified so that they can be protected.
  • Visualization: Depending on the surgical approach, the thyroid gland will be visualized through the incision sites (e.g., with a magnifying lens, if the surgery is open, or through a camera that projects images on a screen, if the surgery is minimally invasive). Of note, carbon dioxide gas is sometimes pumped into the neck area to help make it easier to see.
  • Biopsy (tissue sample): In specific instances (for example, to confirm a diagnosis of thyroid cancer or to check for lymph node spread), the surgeon will remove a piece of thyroid tissue or nearby lymph node. A special doctor called a pathologist will look at the sample under a microscope for cancer cells (while you are still in the operating room). This finding may help dictate how much of the thyroid should be removed during the surgery or if lymph nodes need to be removed.
  • Thyroid removal: The surgeon will then separate the trachea from the thyroid and remove all or part of the gland using surgical instruments—for example, a scalpel or long, thin instruments attached to robotic arms. If the thyroid gland is being removed because of a large or invasive cancer, nearby lymph nodes may also be removed.
  • Drain placement: If there's concern about bleeding, or if the thyroid gland is very large and the surgery has left a large open space, a drain may be placed in the wound site to prevent fluid from accumulating.
  • Closure: The incision(s) will be closed with dissolvable stitches and covered with a clear, protective, waterproof glue called collodium.
  • Prep for recovery: If you were given general anesthesia, it will be stopped. The breathing tube will be removed and you will wake up. You will then be taken to a recovery room.

After the Surgery

In the recovery room, a nurse will monitor your vital signs and help you manage common post-operative symptoms like nausea or pain.

Once you are fully awake and alert (around six hours post-op), you will be discharged home (if an outpatient surgery) or wheeled to a hospital room (if an inpatient surgery).

Most patients who stay in the hospital do so for around 24 hours after their operation.

Recovery

As you recover at home or in the hospital, you can expect the following:

  • You may experience fatigue, sore throat, neck discomfort/stiffness, and voice hoarseness after surgery. These symptoms generally resolve within a few days to weeks. In some cases, voice hoarseness can persist for up to six months.
  • You can usually return to a regular diet after surgery; although, your surgeon may recommend that you avoid heavy, greasy, or spicy meals for the first few days.
  • You can shower the day after surgery. Your surgeon will advise you to not scrub the incision site(s).
  • If you had a drain placed, it will be removed the day after surgery.

Activity

You will have specific activity guidelines to follow after surgery, such as:

  • Avoid heavy lifting for the first two weeks after surgery.
  • Perform gentle neck stretching exercises to reduce neck stiffness.
  • Avoid swimming or taking baths for at least a week after surgery.
  • Avoid driving for two weeks (or longer if you continue to have neck stiffness and/or you are still on pain medication).
  • Return to work approximately one to two weeks after surgery.

Medications and Supplements

Your surgeon will ask that you take certain medications or vitamins after surgery.

  • Pain medication: Pain is generally minimal after surgery and can usually be controlled with an NSAID like ibuprofen or Tylenol (acetaminophen).
  • Calcium: Since the parathyroid glands (which regulate calcium) are located very close to the thyroid gland, they are sometimes injured during surgery. To prevent low calcium levels, your surgeon will recommend over-the-counter calcium supplements after surgery (until your parathyroid glands recover).
  • Vitamin D: Since your parathyroid glands also trigger the activation of vitamin D in your body, vitamin D supplements may be recommended as well.
  • Thyroid medication: Depending on why your surgery was performed and the extent of the procedure, you may be prescribed Synthroid (levothyroxine), which is a thyroid hormone replacement medication.

When to Seek Medical Attention

Call your surgeon if you experience any of the following symptoms:

  • Fever or chills
  • Warmth, or increased redness/swelling/discomfort around your incision site(s)
  • Discharge from your incision site(s)
  • Numbness and tingling around your lips, fingers, or toes

If you experience signs of bleeding in your neck, such as trouble breathing, a high-pitched voice, or increasing swelling in your neck, seek emergency medical attention.

Long-Term Care

You can expect to follow-up with your surgeon about one to two weeks after surgery.

During this appointment, your surgeon will do the following:

  • Evaluate your incision site(s) to ensure proper healing and remove any glue/stitches/strips, if present
  • Monitor you for any unusual changes in your voice
  • Check your blood calcium and vitamin D levels and adjust your supplements, if needed
  • Check your thyroid-stimulating hormone (TSH) levels and, if needed, change the dose of levothyroxine (if applicable)

After the initial follow-up visit with your surgeon, an endocrinologist will probably take over your care. Your endocrinologist will continue to monitor your blood thyroid and calcium levels.

Calcium and vitamin D supplements are usually discontinued once your parathyroid hormone function returns. If you had your whole thyroid gland removed, you will need to keep taking thyroid hormone replacement medication forever.

If you have thyroid cancer, long-term follow-up with thyroglobulin blood tests is regularly done to check for recurring cancer.

Scar Care

In addition to following up with your healthcare team and taking your medications/supplements as prescribed, you will want to care for your thyroid scar after surgery.

Thyroidectomy scar

catinsyrup / Getty Images

You can do this by:

  • Regularly applying sunscreen to your surgical scar and/or covering it up with a turtleneck or scarf for at least six months after your operation.
  • Massaging a small amount of vitamin E or cocoa butter over your scar (starting about two weeks after surgery).

If your scar is still bothering you cosmetically, talk with your healthcare provider. They may recommend silicone sheets or gel, available at a drugstore, that can help reduce the appearance of scars. Less commonly, laser or steroid injections are used to improve the appearance of scars.

Possible Future Surgeries/Therapies

If you have thyroid cancer, you may require radioactive iodine therapy to destroy any thyroid tissue not removed by surgery. Radioactive iodine therapy may also be used to treat cancer that has spread to lymph nodes or other parts of the body.

Finally, another operation on the thyroid gland may be indicated if thyroid cancer recurs.

A Word From Verywell

Your thyroid gland plays a crucial role in your body, so removing it is a significant undertaking. In order to be healthy and feel well after surgery, be sure to adhere to your surgeon's post-operative instructions and attend all of your follow-up appointments.

Also, as you navigate the physical and emotional challenges that come along with thyroid surgery, do not hesitate to reach out to loved ones for support. Be open and talk frequently with your surgical team as well. They are there to help guide you and make this process go as smoothly as possible.

4:47
Was this page helpful?
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Memorial Sloan Kettering Cancer Center. About Your Thyroid Surgery. Updated January 2021.

  2. Lee, D., Chin, C., Heng, C., Perera, S., and I. Witterick. Outpatient Versus Inpatient Thyroidectomy: A Systematic Review and Meta-AnalysisHead and Neck. 2018. 40(1):192-202.

  3. Tae K, Jo YB, Song CM, Ryu J. Robotic and Endoscopic Thyroid Surgery: Evolution and Advances.

    Clin Exp Otorhinolaryngol. 2019 Feb; 12(1): 1–11. doi:10.21053/ceo.2018.00766

  4. Ross DS, Sugg SL. Surgical management of hyperthyroidism. Cooper, DS ed. UpToDate. Waltham, MA: UpToDate. Updated August 2020.

  5. University of Iowa Health Care. Thyroidectomy and Thyroid Lobectomy. Modified November 2020.

  6. Johns Hopkins Medicine. Thyroid Surgery at Johns Hopkins. 2021.

  7. Columbia Thyroid Surgery. Thyroid Surgery.

  8. Worni M, Schudel HH, Seifert E. et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 2008 Dec;248(6):1060-6. doi:10.1097/SLA.0b013e31818c709a

  9. Medical College of Wisconsin. Surgical Oncology. Before and After Thyroid Surgery. 2021.

  10. American Thyroid Association. Care of the Surgical Incision. 2020.

  11. American Cancer Society. Radioactive Iodine (Radioiodine) Therapy for Thyroid Cancer. Revised March 2019.